Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China.
Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute of Wuhan University, and Hubei Key Laboratory of Cardiology, Wuhan, Hubei, P.R. China.
Menopause. 2020 Dec;27(12):1403-1410. doi: 10.1097/GME.0000000000001616.
Reproductive factors are female-specific coronary artery disease (CAD) risk factors. However, the importance of reproductive factors in angiographic obstructive CAD in postmenopausal women remains uncertain. This study aimed to compare reproductive factors between postmenopausal women with no apparent CAD, nonobstructive CAD, and obstructive CAD and identify reproductive risk factors for obstructive CAD.
In this hospital-based cross-sectional study, 1,474 postmenopausal women, admitted with chest pain and referred for invasive coronary angiography were enrolled between April 2013 and October 2018.
Adjusted odds ratio (95% CI) for obstructive CAD were 1.81 (1.03-3.17) for multigravidity (three or more pregnancies), 1.77 (1.14-2.76) for early menopause (≤40 y old), and 1.72 (1.26-2.35) for short reproductive life span (≤30 y). Each additional year in age at menopause or reproductive life span was associated with a 4% reduction in obstructive CAD risk in postmenopausal women (odds ratio, 0.96; 95% CI, 0.94-0.99; P = 0.011). The other reproductive factors, including parity, age at first birth, spontaneous abortion, induced abortion, stillbirth, hypertensive disorders of pregnancy, gestational diabetes mellitus, and age at menarche, were not correlated with obstructive CAD risk in postmenopausal women.
Multigravidity (three or more pregnancies), early menopause, and a shorter reproductive life span were independent risk factors of angiographic obstructive CAD among postmenopausal women, which suggested that pregnancy and ovarian function may be important for the early identification and prevention of increased risk of female angiographic obstructive CAD.
生殖因素是女性特有的冠心病（CAD）危险因素。然而，生殖因素在绝经后女性的血管造影阻塞性 CAD 中的重要性仍不确定。本研究旨在比较绝经后无明显 CAD、非阻塞性 CAD 和阻塞性 CAD 患者的生殖因素，并确定阻塞性 CAD 的生殖危险因素。
本研究为基于医院的横断面研究，共纳入 2013 年 4 月至 2018 年 10 月因胸痛而住院并接受有创冠状动脉造影的 1474 名绝经后女性。
多胎妊娠（≥3 次妊娠）、早绝经（≤40 岁）和生殖寿命短（≤30 岁）的绝经后女性发生阻塞性 CAD 的调整比值比（95%CI）分别为 1.81（1.03-3.17）、1.77（1.14-2.76）和 1.72（1.26-2.35）。绝经年龄或生殖寿命每增加 1 年，绝经后女性发生阻塞性 CAD 的风险降低 4%（比值比，0.96；95%CI，0.94-0.99；P=0.011）。其他生殖因素，包括产次、初产年龄、自然流产、人工流产、死产、妊娠高血压疾病、妊娠期糖尿病和初潮年龄，与绝经后女性发生阻塞性 CAD 的风险无关。
多胎妊娠（≥3 次妊娠）、早绝经和生殖寿命较短是绝经后女性血管造影阻塞性 CAD 的独立危险因素，这表明妊娠和卵巢功能可能对女性血管造影阻塞性 CAD 风险的早期识别和预防具有重要意义。
